Financial Toxicity After Complex GI Surgery : Ann Surg | May 2026

Introduction

Financial toxicity (FT) has emerged as an important yet underrecognized consequence of modern cancer care. Patients undergoing major gastrointestinal (GI) surgery frequently face substantial economic stress related to hospitalization, prolonged recovery, loss of income and ongoing medical expenses. Although FT has been studied in oncology, its impact in complex GI surgical populations and its relationship with patient-reported quality-of-life outcomes remain insufficiently explored.

Problem Statement

Patients undergoing pancreatic, hepatobiliary and other complex GI procedures often experience prolonged treatment pathways involving multimodal therapy and intensive postoperative care. However, limited data exist regarding the prevalence of FT in GI surgery and its influence on emotional and social well-being. Better identification of vulnerable patients is essential to enable timely financial and psychosocial support interventions.

Summary

This prospective study evaluated FT among patients undergoing major GI surgery using validated patient-reported outcome instruments. Nearly one-third of patients experienced clinically significant FT, highlighting the substantial economic burden associated with complex surgical care. Pancreatic resections constituted the largest subgroup, reflecting the intensive treatment requirements of these patients. Importantly, FT demonstrated a meaningful association with emotional and social well-being, emphasizing that financial strain extends beyond economic hardship and directly affects overall quality of life. Single marital status emerged as an independent predictor of FT, suggesting that limited social support networks may increase vulnerability to financial distress. Interestingly, patients not receiving chemotherapy or radiation therapy also showed higher odds of FT, potentially reflecting differences in insurance coverage, employment disruption or access to coordinated oncologic care. The study reinforces the growing recognition that financial health represents a critical component of perioperative outcomes. The authors propose that preoperative identification of high-risk patients may facilitate early referral to financial counseling, social work and supportive care services. Overall, this work highlights FT as a clinically relevant and measurable postoperative burden in GI surgery, supporting the integration of financial risk assessment into multidisciplinary surgical oncology care pathways.